Health Committee on May 26th, 2015

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Yes.

[Janet Currie]

Are you able to hear me?

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Yes.

[Janet Currie]

I can give you an example of a colleague who works as a social worker in an urban school system in Canada. She sees children who have these kinds of problems. As an experienced teacher and social worker, she is able to work with the families and with the children in terms of modifying behaviour, particularly in supporting the parents, because many parents are under a great deal of stress and the child is a kind of manifestation of this stress.

She works with the family in helping the family develop methods of behaviour control and with the school in terms of arrangements, because some kids do find it much harder to sit still and much harder to concentrate. I think that reintroducing things like physical education back into the schools and keeping the physical activity levels high, especially for young boys, is particularly an issue, and I know families that have looked at things like diet and have worked in terms of family relationships because the child needs very careful boundaries and support.

I think all of these alternatives are possible. The problem is that they're not really systemized or offered in schools because the fallback has been medication. That is one of my points: we need to be looking at and developing these alternatives. I know families who have worked very successfully with this model. There are books and resources and there are even health providers who will work with families and not prescribe drugs.

When you have prescription drugs as the fallback, it means that there's a kind of easy answer, although in my opinion it's very risky. You're exposing children with developing brains to a class of drugs related to cocaine and methamphetamines. I've certainly talked to people in the school system who will say that there is an immediate effect, but it's not long-lasting. When you look at the evidence, you see that there's really not a huge amount of evidence that over the long term these drugs accomplish what parents expect them to do.

I don't think there's an easy answer right now, but I would like the schools in particular to start developing options instead of falling back on the medication as the first line of treatment.

[The Chair, Conservative, Ben Lobb]

Mr. Rankin, you can have a brief question, and then we'll move on.

[Murray Rankin, NDP, Victoria, BC]

Thank you.

My question is for you as well, Ms. Currie. You talked about the “prescription cascade” and the fact that sometimes these antidepressants cause other medication to be taken, which itself has side effects. You seemed reluctant to use the word “addiction”. Why? Isn't that exactly what is going on here?

[Janet Currie]

It's exactly what we're talking about. I think there's been a reluctance, particularly by the medical profession, to feel that a drug they're prescribing actually can result in addiction. But there's no question that the dynamics in the brain are similar to.... In fact, researchers with some very good reputations have done comparisons, for example, of Effexor, a very common antidepressant, with other drugs such as cocaine. These drugs affect the structure of the neurons. They affect the neurotransmitters and we don't know a lot about how, as the brain is very complex.

But over a period of time, and it can be a very short time.... Benzodiazepines, in my opinion, should only be used for a period of less than a week. Over a period of time, even a short time, a person either will need a higher dose of the drug for the same effect or will start exhibiting symptoms such as anxiety, agitation, or panic, depending on the drug, symptoms that are indicative of addiction. We call that phenomenon “between dose withdrawal”. I have many individuals who come to me and say that they just don't know what's happening to them, that they're taking a drug for anxiety and having panic attacks. The first thing I look at is how long they have been on the drug and what drug they are taking.

You're absolutely right: “addiction” is the word we should use.

[The Chair, Conservative, Ben Lobb]

Thank you.

Mr. Young.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Thank you, everyone, for your time today.

Janet Currie, first of all, when we talk about mental health, we always end up talking about drugs. Drugs are always involved, either street drugs or prescription drugs. To what extent do over-prescribing and overuse of psychiatric drugs contribute to the suffering of mental health patients and extend their illnesses or, in other words, worsen mental health across Canada?

[Janet Currie]

Well, I mean, you've summed it up. I think the contribution of psychiatric drugs and the extent to which we are using them is contributing to chronic mental health problems and people seeing themselves as chronically ill. I think psychiatric drugs make a huge contribution to that.

Let me talk about my friend Daisy, who is in her 60s. She was prescribed—

[Terence Young, Conservative, Oakville, ON]

Can I interrupt for a second? I have just a few minutes, and I was hoping to get two more questions in. Could you please make a brief answer? Thanks.

[Janet Currie]

Okay.

She was prescribed a heavy-duty sedative when she was a student at university. She had all kinds of psychiatric diagnoses and took more and more psychiatric drugs. She lived a very dysfunctional life for 40 years until she tapered off each one of the psychiatric drugs. She's now living a very positive life.

I think that's part of the reason why we're seeing so much chronicity and long-term disability for mental health patients. I think psychiatric drugs are playing a huge factor in extending those symptoms and the chronic conditions.

[Terence Young, Conservative, Oakville, ON]

Thank you.

If patients were given clearly worded safety warnings for anti-depressants with regard to suicide, that SSRIs and SNRIs can lead to suicide, could suicides be reduced?

[Janet Currie]

I don't know how much attention people pay to safety warnings. I think it's one small component of drug safety. I think it should be done.

I think people underestimate side effects. I think health providers need to know that when a person is starting on an anti-depressant they should be very carefully monitored. I'm talking about daily monitoring. That is what the drug manufacturers recommend. Who monitors a person getting an anti-depressant? Does the physician tell the patient not to increase their dose, reduce their dose, or try to stop without discussing it with them? Does the physician tell the patient to call them when they are experiencing side effects, or talk to the family?

I think those kinds of things might be more effective.

[Terence Young, Conservative, Oakville, ON]

We know that there are much higher rates of suicide amongst first nations youth. We also know that the prescribing of anti-depressants is much higher for first nations youth. Do you make a connection with those two facts?

[Janet Currie]

Absolutely. When you look at the aboriginal population, and aboriginal women particularly, that group gets a high level not just of psychiatric drugs but also opiates and opiate painkillers. That's a dynamite combination, opiates and psychiatric drugs. I definitely think this is something we should look at. We certainly cannot dismiss the socio-economic factors and other issues as contributors to suicide. I'm not in any way trying to dismiss that. But we really need to look at the contribution of psychiatric drugs, and of other drugs a person might be taking, to depression. I would really welcome that kind of analysis.

I was also going to say that in the case of prisoners, as mentioned by a previous speaker, in terms of working with people who have been incarcerated or who are on parole, again, this is another population group that uses a very high rate of prescription drugs. One needs to look at their ability to function in relation to the drugs they're taking.

[Terence Young, Conservative, Oakville, ON]

Thank you.

Dr. Rehm, I want to ask you about the relationship between crime, alcohol, and marijuana. I just read in the Carleton University paper today that a former student, 26 years old, has gone to prison for a year because several years ago, after a night of smoking marijuana and drinking, he raped a sleeping woman—a woman who had trusted him. She has PTSD. She has attempted suicide. He's gone to prison. This is a tragedy all around.

How often does marijuana lead to psychiatric illness, either through crime or as a reaction to smoking this powerful narcotic?

[Dr. Jürgen Rehm]

Basically, there is clear evidence that marijuana and smoking marijuana can trigger mental disorders—for example, psychotic symptoms and schizophrenia, as has been shown—in vulnerable people. That means that overall we do have this connection.

This is not a very frequent connection. If you look into the deaths and the very serious events related to marijuana, the most important effect on mortality is actually traffic—that means smoking marijuana and being in traffic—and lung cancer. That has the same effect as smoking cigarettes, albeit, of course, on a way smaller scale, because marijuana is smoked by fewer people.

[Terence Young, Conservative, Oakville, ON]

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

The bells are ringing. The votes aren't until 5:45. Ms. Fry hasn't asked a question yet. Is there unanimous consent to allow Ms. Fry to have a question so she can get a question on the record? It may not be a full round, but at least one question—

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

We're a long way from the Hill, so—

[The Chair, Conservative, Ben Lobb]

Okay, Ms. Fry, a brief question so you are on the record.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

I want to thank the committee for allowing me this opportunity to ask a question.

We've heard about the dangers and the adverse effects of drugs in certain mental illnesses, but we also know there is a need at certain times for appropriate medication for certain mental illnesses.

Mr. Weber, I wanted to talk about an integrated community approach, with early risk factors being picked up in, say, a school and then that person moving into support systems, with the particular child being referred to the right person to look after them, whether a psychotherapist or a tertiary care person.

You talked about the German Nuremberg model. Can you tell us a little about that? It sounds like a very innovative model for dealing with the problem.

[George Weber]

It's a model, as we have done here in the Ottawa area, that brings all elements of the community together that may have some influence in early identification of people with suicidal ideation and then dealing with that, by pulling all the resources together, because nobody has the ultimate, whole package of resources.

The first thing to do is to investigate where the suicides took place and the means, and things of that nature, and start at the front end to try to take away some of those means. That has also been done in subway stations in some parts of Canada. So it deals with that. Then, fundamentally, early identification is probably the big area, and then making sure that for those people who have high levels of suicidal ideation, there is a wraparound of resources from the community to help them get through that and build in resilience so they can handle whatever is affecting their vulnerability.

It's total community support.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Thank you, Ms. Fry.

We can't go any further, or I'll get impeached.

The meeting is adjourned.